Utah lawmakers approved a more modest alternative to Republican Gov. Gary Herbert’s Medicaid expansion plan on Friday after a contentious debate.
The House’s 56-18 vote sends the measure to the state Senate. Herbert’s measure, known as Healthy Utah, passed the state Senate late last month but failed on Wednesday night to make it out of a House committee. The panel instead approved the alternative, called Utah Cares, which costs almost as much as Herbert’s plan but covers a much smaller population. The House bill would bring in a much smaller pot of federal matching grant money the governor’s plan.
House Majority Whip Francis Gibson, R-Mapleton, told representatives before the vote they should “feel free” to oppose Utah Cares, but called it “analogous to the guy in the desert who walks past a glass of water because he wants a gallon,” according to the Deseret News of Salt Lake.
Democrats tried to substitute Herbert’s proposal for the Utah Cares bill, sponsored by House Majority Leader Jim Dunnigan, the chamber’s second-ranked Republican, but fell short in a 22-52 vote, even as 10 Republicans joined the dozen members of the minority party.
Rep. Marie Poulson, D-Cottonwood Heights, a member of the Legislature’s Health Reform Task force that studied options for the Medicaid expansion available under the Affordable Care Act, said she was offended by the name of the House plan, according to the Deseret News account of the debate:
“We can care more. Utah needs us to care more about the lives of our citizens than we do about making a political statement,” Poulson said, calling the limited coverage offered by Utah Cares a “huge missed opportunity.”
Herbert had said he was open to suggestions floated by some lawmakers to approve both Healthy Utah and the rival plan, with one taking effect for a couple of years and the other being implemented later if the original plan doesn’t work well. But Herbert insisted that Healthy Utah should be implemented initially and that the narrower plan be available as a fallback option of costs turn out to be too high.
Herbert said that his program could be capped so that if costs exceed expectations, new applicants would not get the same benefits as people who were already enrolled and would be grandfathered into that level of coverage. Herbert won assurances from Health and Human Services Secretary Sylvia Mathews Burwell that the unusual cap would be approved.
The governor also sought to portray the House version as the fiscally unsustainable option. Because that bill would not expand Medicaid under the health care law, it would attract fewer federal dollars.
The health care law provides a generous matching rate to states that expand to the population that Obama administration officials want. The administration will cover all of the costs through 2016 for people who qualify under expanded eligibility guidelines if states broaden the population to anyone with income up to 138 percent of the federal poverty level. That full financing phases down until the federal Department of Health and Human Services will cover 90 percent of the costs for those people starting in 2020.
The Utah Cares plan would not meet the federal requirements for the 100 percent federal matching money and cost $56 million in state revenues and draw down $139 million in federal matching grants in 2021, according to House legislative estimates. The program would cover an additional 32,000 adults with comprehensive care and provide basic care to 61,000 adults. The estimates include people who qualify under previous eligibility guidelines but learn of benefits and enroll for the first time.
The governor’s version would have cost $78 million in state funds while attracting $648 million in federal matching moneyin 2021. It would cover about 146,000 people.
Under Utah legislative rules, it would be rare for Dunnigan’s bill and Herbert’s plan to be reconciled in a conference committee.
“You can never say never, however,” said Gates, the spokesman for House Republicans. “And Rep. Dunnigan is never one to close a door.”
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